CLIPP 18

Question 1

two examples of difficulty w feeding

Answer 1

incresed resp and increased WOB

Question 2

problem w/ maternal milk prod indicated if

Answer 2

infanti s hungry and trying to feed often

Question 3

young infants usually nurse for __ min and at __ frequeny

Answer 3

10-30 mi, as often as 1-2h

Question 4

normal newborn RR

Answer 4

40-60

Question 5

what types of murmurs are pathologic

Answer 5

diastolic, continuous (PDA), grade3+, or if thrill (grad4)

Question 6

normal liver edge size infancy

Answer 6

normal liver edge in infancy is 1-2cm below R costal margin. Liver size in children is often described by the distance below the right costal margin, rather than actual liver span. after Thus, hyperexpansion of the lungs can create a false impression of hepatomegaly. In a child with apparent hepatomegaly and respiratory symptoms, it is important to try to assess the actual liver size.

Question 7

classic findings of CHF in infancy

Answer 7

dyspnea with feedings, diaphoresis, poor growth, an active precordium and hepatomegaly in this period of a few weeks after birth

Question 8

still’s murmur

Answer 8

best heard left lower sternal border while supine and is vibratory/musical in nature and INNOCENT (innocent murmurs often at 3-7yo)

Question 9

is second heart sound normally split?

Answer 9

if no, then murmur is not innocent

Question 10

which two CHDs show up around 3-5yo

Answer 10

ASD, coarct

Question 11

AS vs PS vs ASD vs VSD vs PDA vs innocent

Answer 11

AS: SEM followed by diastolic murmur in AI
PS: prominent Sys ej click after s1, harsh SEM
ASD: wide split s2 and systolic pulmonic flow murmur
VSD: blowing, holosystolic
PDA: continuous, machinelike
Innocent: often LLSB, vibratory/low pitched

Question 12

infant w vhf typically presents w/

Answer 12

feeding difficulties and respiratory symptoms.

The history will often reveal that the infant is feeding for longer periods of time than normal, and that the feedings are terminated due to respiratory distress.
Infants frequently become diaphoretic with feedings.
Ultimately, due to poor feeding and increased caloric expenditure, poor weight gain ensues.

Question 13

4 CHD presenting w/ chf and murmur

Answer 13

AS, coarct, PDA, vsd

Question 14

hallmark CXR findings of L to R shunt in CHD

Answer 14

cardiomegaly and increased plum markings

Question 15

EKG in vsd

Answer 15

biventricular voltage - big voltage sin v1+v2 qrs because of LV vol overload and RV pressure overload

Question 16

large vs moderate vsd in terms of pathophys

Answer 16

Large VSD: The classic ECG finding is RVH due to RV pressure overload (pulmonary hypertension). This ECG also has an upright T wave in lead V1, which is an additional sign of RVH. in LARGE vsd, no pressure gradient bc RV and LV are equalized.

Moderate-size VSD: The classic ECG finding is LVH, due to LV volume overload. (Although counterintuitive, a VSD leads to left-heart dilation by means of increased pulmonary blood flow returning to the left heart. The VSD shunt occurs in systole, when the right ventricle is also contracting, so the right ventricle ultimately does not fill with the extra volume and dilate, as the VSD flow is immediately ejected into the pulmonary arteries.)

Question 17

shunting in vsd

Answer 17

leads to LV vol overload due to increased blood due to the blood going to the R and then coming back to L heart

Question 18

vsd meds in infancy, med most used as infant diuretic

Answer 18

dig, lasix, ace inhibitor

-lasix

Question 19

when is a surgery decision in a vdd infant made and why

Answer 19

6 months of age, for fear of eisenmerngers

A heart murmur from a VSD is typically not appreciated in the immediate newborn period, as the pulmonary vascular resistance is still quite elevated. During this time, since the pulmonary vascular resistance equals the systemic vascular resistance, there is no shunting of blood through the open VSD. However, after a few days to weeks after birth, the pulmonary vascular resistance decreases, and the murmur appears, reflecting the shunted flow of blood through the open VSD (from left to right).

Question 20

route of majority of fetal circ

Answer 20

RA > RV > ductus arteriosus > systemic circulation